We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands.
- Authors
Slim, Marleen A; Appelman, Brent; Peters-Sengers, Hessel; Dongelmans, Dave A; Keizer, Nicolette F de; Schade, Rogier P; Boer, Mark G J de; Müller, Marcella C A; Vlaar, Alexander P J; Wiersinga, W Joost; Vught, Lonneke A van; group, NICE COVID-19 Research Consortium and the COVIDPredict study
- Abstract
Background Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive. Methods We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used: unadjusted, adjusted, propensity matched, and propensity weighted. Results Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67–64 years; P <.001), in in-hospital mortality on the ward (21%–15%; P <.001), and a trend in the ICU (24%–16%; P =.148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22–1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03–1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69–0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality. Conclusions Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
- Subjects
NETHERLANDS; SARS-CoV-2; COVID-19 treatment; HOSPITAL patients; COVID-19; COHORT analysis
- Publication
Open Forum Infectious Diseases, 2022, Vol 9, Issue 12, p1
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofac632